A Consensus-Based Framework for the Psychosocial Evaluation of Pediatric Candidates for Cardiothoracic Transplant and Ventricular Assist Devices

Published 1 April 2025

Debra Lefkowitz PsyD; Kelli Triplett; Lauren Schneider, PsyD; Kara West; Corinne Anton; Kelly Rea; Micah Brosbe; Elizabeth Christofferson; Lillian Christon, PhD, MA; Nadine Kasparian; Alexandra Lamari-Fisher; Katie McIntyre, PsyD; Jill Plevinsky; Scott Auerbach, MD; Neha Bansal; Christian Benden, MD, MBA, FCCP; Molly Dugan; Jonathan Edelson, MD; Jami Gross-Toalson, PhD; Gillian Mayersohn; Jenny Prufe; Rachel White, MD; Jenny Wichart; Jo Wray, PhD, DHP (NC); Melissa Cousino, PhD.

J Heart Lung Transplant. Apr 2025.

• Advanced Heart Failure & Transplantation
• Advanced Lung Failure & Transplantation
• Cardiothoracic Surgery
• Endorsement
• Mechanical Circulatory Support
• Pediatrics
• Publications & Journals
• Standards & Guidelines

The psychosocial evaluation plays a critical role in the multidisciplinary assessment of pediatric patients for thoracic organ transplantation or ventricular assist device (VAD) placement. However, there is considerable practice variation with regard to the content and process of the evaluation, with no known recent published guidelines. Furthermore, the pediatric evaluation necessarily differs from the adult evaluation in a number of substantive ways, including caregiver roles and decision-making.

In an effort to address the gap in published literature, a writing committee of 25 multidisciplinary experts in pediatric cardiothoracic transplantation/VAD was assembled from across several organizations, including the International Society for Heart and Lung Transplantation (ISHLT), the International Pediatric Transplant Association (IPTA), the Pediatric Heart Transplant Society (PHTS), the Advancing Cardiac Therapies Improving Outcomes Network (ACTION), and Transplant Families. The resulting consensus-based framework represents the first of it's kind specific to both the content and process of the psychosocial evaluation for pediatric cardiothoracic transplantation/VAD, the purpose of which is to offer flexibility, promote consistency, and acknowledge the complexities of assessing pediatric patients.

Attention was paid to relevant ethical, cultural and health equity considerations inherent in the pediatric evaluation process. Rather than provide a proscriptive evaluation process, the goal was to create a flexible framework to encourage consistency across centers, while also acknowledging the complexities inherent in evaluating children and their families for cardiothoracic transplant and VAD.

The International Society for Heart and Lung Transplantation (ISHLT) endorsed this document in 2025.

Read at JHLT